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POLITICO 44

President Barack Obama and congressional Democrats pushing a massive health care reform package have yet to answer a central question for middle-class Americans: What’s in it for me?

As Democrats hustle to pass legislation by August, strategists say they need to prove to this bloc of voters — insured, but worried about the stability of their coverage — that they will personally benefit.

“The American people are ready to make a leap, but they need to be convinced of the value of what they’re buying,” according to a memo from Third Way, a centrist think tank and strategy group, based on a survey by Benenson Strategy Group, one of Obama’s pollsters. “Stability can offer that.”

The seven-page memo, which has begun circulating on Capitol Hill and through the administration, was provided to POLITICO ahead of its public release Monday.

Obama and Democratic lawmakers learned the lessons of Bill Clinton’s failed reform effort in 1993-94 by focusing this time less on covering the 47 million uninsured than lowering costs and protecting the choice of doctors and plans for those who are covered.

But they need to make a more visceral case for overhauling the system, said Jim Kessler, the vice president for policy at Third Way, who co-authored the memo with Anne Kim, director of the group's economic program.

“Most of the current words used to describe and sell reform are computational words — cost, access, quality,” Kessler said. “They are Mr. Spock words, not Dr. Spock words. … You need to use terms that are warm, evocative and emotional.”

Kessler and Kim took issue with some of the very messages Obama and other Democrats have used to frame the debate. Obama's three principles for reform, as listed on the Organizing for America website, are "reduce costs, guarantee choice and ensure affordable care for all."

“To make reform a personal imperative (i.e., to answer the question ‘what’s in it for us?’), reformers must make a substantial offer to the middle class that truly reflects their health care circumstances and is something that they feel the government can actually deliver,” the memo states.

“Simply maintaining that Americans will be allowed to keep their own doctors or their current coverage if they like it is not a meaningful offer. Rather, they are defensive arguments implying that health care reform will cost middle-class Americans, not help them. These arguments may even inadvertently buttress the notion that health care reform is not about them but about someone else (‘don’t worry, you won’t be affected’).”

Insurance-market reforms in the Democratic plan, such as prohibiting insurers from denying coverage or charging higher rates based on preexisting conditions, are “actually game-changing stability offers for the middle class — offers that haven’t been explained because of the complexity of reform and the handful of controversial issues that have dominated the debate,” Kessler and Kim wrote, sidestepping any discussion of the public insurance option.

Third Way suggests an alternative messaging frame: “Stable coverage that cannot be taken away from you through life’s ups and downs. Stable costs that won’t eat away an increasing share of your paycheck. Stable quality so you can get the treatment you need, when you need it, and from the doctor you choose.”

The House Democratic Caucus has already incorporated the “stability and peace of mind” message into its daily talking points, according to the June 23 memo distributed to members. There are now four buzz words: cost, choice, quality — and stability.

Public support for health care reform is almost identical to what it was in 1992, at around 65 percent, the memo states. But even among those who support it, only 29 percent believe their premiums will go down and just 34 percent believe the reform effort will boost the quality of their health care, according to the Benenson poll of 1,251 voters conducted between May 27 and June 2.

“The lesson to be learned … is that there’s a difference between ‘supporting’ reform and ‘wanting’ it,” the memo states. “To win the battle of public opinion, reformers must move the middle class from being passive supporters of health care reform to being its active advocates — or they risk losing that support in the heat of the debate.”

Readers' Comments (11)

what we have now is a bunch of profit first driven killers-so what do we need to decide-most of us have no coverage and the ones that think they do will find out different when someone in their family gets really sick